Importance: A lot of women suffer from sexual disfunctions, which most of the times cause pain and discomfort. Many genito-pelvic pain disorders appear in the form of contractions or pelvic floor muscle tension, which makes any type of penetration (sexual, tampons, gynaecological examination tools) impossible. In this condition, a woman cannot control these muscle contractions and experiences moderate to intense pain. Objectives: To summarise published evidence on efficacy of physiotherapy for treating female sexual pain disorders, ways to evaluate the condition of a patient and to find the correct treatment. Evidence review: A literature search of Cochrane, PubMed, Journal of Sexual Medicine and Urogynecology Journal databases, SciELO, Google Scholar, Wiley Online Library and University of Barcelona Library was conducted. Findings: Physiotherapy techniques are used to strengthen pelvic floor muscles and relieve pain. Kegel exercises improve the symptoms of sexual pain disorders as they deal with weakened muscles. Vaginal cones exercises are used to strengthen the muscles by means of introduction of gradually increasing weights in the vagina. Biofeedback helps to increase muscle awareness and auto-evaluation of performed exercises. Thermotherapy relaxes muscles and increases elasticity of tissues which helps to reduce pain. Electro-stimulation improves the functionality of muscles. Myofascial therapy consists mainly in manual therapy and in liberating painful trigger points. Conclusions: The role of pelvic physiotherapy is to solve the problems related to sexual pain, recovering the pelvic floor by increasing muscle awareness and proprioception, improving muscle relaxation, toning the muscles and increasing the elasticity of the tissues in order to eliminate or reduce pain. Different exercise techniques, biofeedback, manual therapy and insertion techniques, as well as electro-stimulation and thermotherapy are used to achieve positive results.
Defining Sexual Health Report of a Technical Consultation on Sexual Health 28-31 January 2002, Geneva. World Health Organisation, Geneva. http://www.who.int/reproductivehealth/publications/sexual_health/defining_sexual_health.pdf
Rogers, R.G., Rockwood, T.H., Constantine, M.L., Thakar, R., Kammerer-Doak, D.N., Pauls, R.N., et al. (2013) A New Measure of Sexual Function in Women with Pelvic Floor Disorders (PFD): The Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). International Urogynecology Journal, 24, 1091-1103.
Morkved, S., Bo, K. and Fjortoft, T. (2002) Effect of Adding Biofeedback to Pelvic Floor Muscle Training to Treat Urodynamic Stress Incontinence. Obstetrics & Gynecology, 100, 730-739.
Berghmans, L.C., Frederiks, C.M., de Bie, R.A., Weil, E.H., Smeets, L.W., van Waalwijk van Doorn, E.S. and Janknegt, R.A. (1996) Efficacy of Biofeedback, When Included with Pelvic Floor Muscle Exercise Treatment, for Genuine Stress Incontinence. Neurourology and Urodynamics, 15, 37-52.
Koh, C.E., Young, C.J., Young, J.M. and Solomon, M.J. (2008) Systematic Review of Randomized Controlled Trials of the Effectiveness of Biofeedback for Pelvic Floor Dysfunction. British Journal of Surgery, 95, 1079-1087.
Hüter-Becker, A., Schewe, H. and Heipertz, W. (2005) Terapia Física: Termoterapia, mecanoterapia, electroterapia, ultrasonidos, fototerapia e inhalación. [Physical Therapy: Thermotherapy, Mechanotherapy, Electrotherapy, Ultrasound, Phototherapy and Inhalation]. Paidotribo, Barcelona.
Murina, F., Bianco, V. and Radici, G. (2008) Transcutaneous Electrical Nerve Stimulation to Treat Vestibulodynia: A Randomised Controlled Trial. BJOG, 115, 1165-1170. http://dx.doi.org/10.1111/j.1471-0528.2008.01803.x
Itza, F., Zarza, D., Serra, L., Gómez-Sanchad, F., Salinas, J. and Allona-Almagro, A. (2010) Myofascial Pain Syndrome in the Pelvic Floor: A Common Urological Condition. Actas Urológicas Espanolas, 34, 318-326.
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders. 5th Edition, American Psychiatric Publishing, Arlington. http://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596
American Psychiatric Association (2013) Highlights of changes from DSM-IV-TR to DSM-5. American Psychiatric Publishing, Arlington. http://www.dsm5.org/documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf
Reissing, E., Yitzchak, B. and Samir, K. (1999) Does Vaginismus Exist?: A Critical Review of the Literature. Journal of Nervous & Mental Disease, 187, 261-274. http://dx.doi.org/10.1097/00005053-199905000-00001
Flanagan, E., Herron, K.A., O’Driscoll, C. and Williams, A.C. (2015) Psychological Treatment for Vaginal Pain: Does Etiology Matter? A Systematic Review and Meta-Analysis. The Journal of Sexual Medicine, 12, 3-16.
Hay-Smith, E.J., Herderschee, R., Dumoulin, C. and Herbison, G.P. (2011) Comparison of Approaches to Pelvic Floor Muscle Training for Urinary Incontinence in Women. Cochrane Database of Systematic Reviews, 7, CD009508.